| Cook Behavioral Health | |
|
7230 Engle Rd Ste 304 Fort Wayne IN 46804-2209 | |
| (260) 483-2400 | |
| (260) 960-9361 |
| Full Name | Cook Behavioral Health |
|---|---|
| Speciality | Psychologist |
| Location | 7230 Engle Rd Ste 304, Fort Wayne, Indiana |
| Authorized Official Name and Position | Jason T Cook (OWNER) |
| Authorized Official Contact | 2604832400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cook Behavioral Health 7230 Engle Rd Ste 304 Fort Wayne IN 46804-2209 Ph: (260) 483-2400 | Cook Behavioral Health 7230 Engle Rd Ste 304 Fort Wayne IN 46804-2209 Ph: (260) 483-2400 |
| NPI Number | 1265691257 |
|---|---|
| Provider Enumeration Date | 06/04/2008 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 3274584487 |
|---|---|
| Medicare Enrollment ID | O20050204000529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265691257 | NPI | - | NPPES |
| 200290630 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 20041587A (Indiana) | Primary |
| Provider Name | Jason T Cook |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043283641 PECOS PAC ID: 7618928821 Enrollment ID: I20050204000566 |
| Provider Name | Karah Sophia Wynn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174180939 PECOS PAC ID: 4082078936 Enrollment ID: I20230912001633 |
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